Case presentation

2008-04-18
R1 이진영

내원 전일 abrupt periumbilical sever pain. . 내원 3 일 전부터 epigastric discomfort. Case 이 @ 윤 66/M Present illness Chronic constipation hx. Plain abdomen x-ray 상 free air 소견보여 transfer. 최근 1 주일간 defecation 하지 못함 .

Mucosa unremarkable . antemesenteric side No intraluminal lesion No tumorous lesion Cecum and ascending colon adhesion with inflammatory appearance with dirty material.4cm perforation at cecum.

Pathology .

Microscopic .

tricyclic antidepressants. tranquilizers . Stercoral colitis Definition Inflammatory process of colonic wall related to fecal impaction Main causative factor : Severe chronic constipation elderly : often live in nursing homes young patients : neurologically impaired slow transit time : opiates.

Stercoral colitis Mechanism Conglomeration of dehydrated fecal material → Increased intraluminal pressure → Decreases blood supply → Ischemia → ulceration and perforation Nevertheless Stercoral ulceration does not always occur among constipation cases Not every stercoral ulceration results in colon perforation. .

Stercoral colitis Stercoral ulceration: M/C in antimesenteric aspect of sigmoid colon hypoperfusive status decreasing water content in the stool narrow diameter high intraluminal pressures .

CT Finding Uncomplicated fecal impaction Stranding of pericolonic fat Presence of -extraluminal bubbles of gas -abscess .

colonic dilatation colonic perforation size 1 cm or more ulcerations on the antimesenteric border If frank perforation occurs -> fecal material within the peritoneal cavity in close proximity to the perforation site Histology transmural necrosis ulcer margins sharply demarcated nonspecific inflammatory changes no additional colonic pathology is found . Diagnosis Hystory of chronic constipation or fecal impaction Intraoperative findings generalized peritonitis.

Treatment Most cases of uncomplicated stercoral colitis successfully treated with disimpaction Stercoral perforation broad spectrum antibiotics : initiated in all the patient resection of the colon segment with an end colostomy primary repair Underlying disease Tx Mortality related to stercoral perforation : 30% to 55% . prompt exploration may decrease that rate .

142(1):98 . Reference Stercoral Colitis Leading to Fatal Peritonitis: CT Findings Cathleen et al. 184:1189-1193 Management of patients with stercoral perforation of the sigmoid colon: Report of five cases Wen-Shih Huang et al. World J Gastroenterol 2006 January 21. AJR 2005.12(3):500-503 Image of the Month—Perforated Stercoral Ulcer Arch Surg. 2007.